Impact of Nutritional Vitamin D Supplementation on Parathyroid Hormone and 25-hydroxyvitamin D Levels in Non-dialysis Chronic Kidney Disease: a Meta-analysis

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2021 Oct 4

PMID 34603696

Citations 12

Authors

Jordi Bover

Joel Gunnarsson

Philipp Csomor

Edelgard Kaiser

Giuseppe Cianciolo

Rosa Lauppe

Affiliations

Soon will be listed here.

Abstract

Background: Secondary hyperparathyroidism (SHPT) is a common and major complication in chronic kidney disease (CKD), reflecting the increase of parathyroid hormone (PTH) in response to reduced vitamin D signalling and hypocalcaemia. This meta-analysis evaluated the impact of nutritional vitamin D (NVD) (cholecalciferol or ergocalciferol) on SHPT-related biomarkers.

Methods: A systematic literature search was performed in PubMed to identify relevant randomized control trials to be included in the meta-analysis. Fixed- and random-effects models were used to pool study-level results. Effects were studied within NVD study arms and relative to control groups (placebo/no treatment); the former in order to identify the effect of actively altering biomarkers levels.

Results: Reductions in PTH from supplementation with NVD were small when observed within the NVD study arms (pooled reduction: 10.5 pg/mL) and larger when compared with placebo/no treatment (pooled reduction: 49.7 pg/mL). NVD supplementation increased levels of 25-hydroxyvitamin D [25(OH)D] in both analyses (increase within NVD study arm: 20.6 ng/mL, increase versus placebo/no treatment: 26.9 ng/mL). While small and statistically non-significant changes in phosphate and fibroblast growth factor 23 were observed, NVD supplementation caused calcium levels to increase when compared with placebo/no treatment (increase: 0.23 mg/dL).

Conclusions: Our results suggest that supplementation with NVD can be used to increase 25(OH)D to a certain extent, while the potential of NVD to actively reduce PTH in non-dialysis-CKD patients with SHPT is limited.

Citing Articles

Native vitamin D in CKD and renal transplantation: meaning and rationale for its supplementation.

Alfieri C, Molinari P, Vettoretti S, Fusaro M, Bover J, Cianciolo G J Nephrol. 2024; 37(6):1477-1485.

PMID: 39223353 DOI: 10.1007/s40620-024-02055-x.

Evaluation of Therapies for Secondary Hyperparathyroidism Associated with Vitamin D Insufficiency in Chronic Kidney Disease.

Strugnell S, Csomor P, Ashfaq A, Bishop C Kidney Dis (Basel). 2023; 9(3):206-217.

PMID: 37497207 PMC: 10368011. DOI: 10.1159/000529523.

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines.

Bover J, Masso E, Gifre L, Alfieri C, Soler-Majoral J, Fusaro M Nutrients. 2023; 15(7).

PMID: 37049415 PMC: 10097233. DOI: 10.3390/nu15071576.

Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population.

Barbuto S, Perrone V, Veronesi C, Dovizio M, Zappulo F, Vetrano D Nutrients. 2023; 15(2).

PMID: 36678208 PMC: 9867108. DOI: 10.3390/nu15020336.

[Diagnosis and treatment of osteoporosis in patients with chronic kidney disease : Joint guidelines of the Austrian Society for Bone and Mineral Research (ÖGKM), the Austrian Society of Physical and Rehabilitation Medicine (ÖGPMR) and the Austrian...].

Cejka D, Wakolbinger-Habel R, Zitt E, Fahrleitner-Pammer A, Amrein K, Dimai H Wien Med Wochenschr. 2022; 173(13-14):299-318.

PMID: 36542221 PMC: 10516794. DOI: 10.1007/s10354-022-00989-0.

References

Dreyer G, Tucker A, Harwood S, Pearse R, Raftery M, Yaqoob M . Ergocalciferol and microcirculatory function in chronic kidney disease and concomitant vitamin d deficiency: an exploratory, double blind, randomised controlled trial. PLoS One. 2014; 9(7):e99461. PMC: 4090117. DOI: 10.1371/journal.pone.0099461. View

Zhang D, Li H, Yin D, Wang L, Ma Y . Ergocalciferol versus calcitriol for controlling chronic kidney disease mineral bone disorder in stage 3 to 5 CKD: A randomized controlled trial. Eur J Pharmacol. 2016; 789:127-133. DOI: 10.1016/j.ejphar.2016.07.019. View

Kendrick J, Andrews E, You Z, Moreau K, Nowak K, Farmer-Bailey H . Cholecalciferol, Calcitriol, and Vascular Function in CKD: A Randomized, Double-Blind Trial. Clin J Am Soc Nephrol. 2017; 12(9):1438-1446. PMC: 5586569. DOI: 10.2215/CJN.01870217. View

Nigwekar S, Tamez H, Thadhani R . Vitamin D and chronic kidney disease-mineral bone disease (CKD-MBD). Bonekey Rep. 2014; 3:498. PMC: 3944129. DOI: 10.1038/bonekey.2013.232. View

Kandula P, Dobre M, Schold J, Schreiber Jr M, Mehrotra R, Navaneethan S . Vitamin D supplementation in chronic kidney disease: a systematic review and meta-analysis of observational studies and randomized controlled trials. Clin J Am Soc Nephrol. 2010; 6(1):50-62. PMC: 3022248. DOI: 10.2215/CJN.03940510. View

Strugnell S, Sprague S, Ashfaq A, Petkovich M, Bishop C . Rationale for Raising Current Clinical Practice Guideline Target for Serum 25-Hydroxyvitamin D in Chronic Kidney Disease. Am J Nephrol. 2019; 49(4):284-293. DOI: 10.1159/000499187. View

Moe S, Saifullah A, LaClair R, Usman S, Yu Z . A randomized trial of cholecalciferol versus doxercalciferol for lowering parathyroid hormone in chronic kidney disease. Clin J Am Soc Nephrol. 2010; 5(2):299-306. PMC: 2827596. DOI: 10.2215/CJN.07131009. View

Doorenbos C, van den Born J, Navis G, de Borst M . Possible renoprotection by vitamin D in chronic renal disease: beyond mineral metabolism. Nat Rev Nephrol. 2009; 5(12):691-700. DOI: 10.1038/nrneph.2009.185. View

Jean G, Souberbielle J, Chazot C . Vitamin D in Chronic Kidney Disease and Dialysis Patients. Nutrients. 2017; 9(4). PMC: 5409667. DOI: 10.3390/nu9040328. View

10.

Yee-Moon Wang A, Fang F, Chan J, Wen Y, Qing S, Chan I . Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial. J Am Soc Nephrol. 2013; 25(1):175-86. PMC: 3871774. DOI: 10.1681/ASN.2013010103. View

11.

Kovesdy C, Lu J, Malakauskas S, Andress D, Kalantar-Zadeh K, Ahmadzadeh S . Paricalcitol versus ergocalciferol for secondary hyperparathyroidism in CKD stages 3 and 4: a randomized controlled trial. Am J Kidney Dis. 2011; 59(1):58-66. DOI: 10.1053/j.ajkd.2011.06.027. View

12.

Agarwal R, Georgianos P . Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease. Nephrol Dial Transplant. 2016; 31(5):706-13. DOI: 10.1093/ndt/gfw080. View

13.

Cunningham J, Locatelli F, Rodriguez M . Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011; 6(4):913-21. DOI: 10.2215/CJN.06040710. View

14.

. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2019; 7(1):1-59. PMC: 6340919. DOI: 10.1016/j.kisu.2017.04.001. View

15.

Alvarez J, Law J, Coakley K, Zughaier S, Hao L, Shahid Salles K . High-dose cholecalciferol reduces parathyroid hormone in patients with early chronic kidney disease: a pilot, randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2012; 96(3):672-9. PMC: 3417221. DOI: 10.3945/ajcn.112.040642. View

16.

Holick M . Vitamin D deficiency. N Engl J Med. 2007; 357(3):266-81. DOI: 10.1056/NEJMra070553. View

17.

Geng S, Kuang Z, Peissig P, Page D, Maursetter L, Hansen K . Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int. 2019; 30(10):2019-2025. DOI: 10.1007/s00198-019-05033-3. View

18.

Segersten U, Correa P, Hewison M, Hellman P, Dralle H, Carling T . 25-hydroxyvitamin D(3)-1alpha-hydroxylase expression in normal and pathological parathyroid glands. J Clin Endocrinol Metab. 2002; 87(6):2967-72. DOI: 10.1210/jcem.87.6.8604. View

19.

Westerberg P, Sterner G, Ljunggren O, Isaksson E, Elvarson F, Dezfoolian H . High doses of cholecalciferol alleviate the progression of hyperparathyroidism in patients with CKD Stages 3-4: results of a 12-week double-blind, randomized, controlled study. Nephrol Dial Transplant. 2017; 33(3):466-471. PMC: 6018863. DOI: 10.1093/ndt/gfx059. View

20.

Thadhani R, Appelbaum E, Pritchett Y, Chang Y, Wenger J, Tamez H . Vitamin D therapy and cardiac structure and function in patients with chronic kidney disease: the PRIMO randomized controlled trial. JAMA. 2012; 307(7):674-84. DOI: 10.1001/jama.2012.120. View